Doug Dean: Expanding Medicaid is about community, not the bottom line

Elliot Health System provides care to more than 150,000 people in our community through the dedicated service of more than 500 physicians and 3,500 outstanding employees. Elliot is the largest provider of health care in southern New Hampshire, and the decision whether to expand Medicaid is critical to our mission and our patients.

We have probably all seen quite a few financial analyses that show the various costs and benefits of expanding Medicaid. Recently, we took note of a study by the Lewin Group, which takes a careful look at some of the secondary financial impacts and concludes that there are substantial benefits to Medicaid expansion. We have also been asked about a story recently published in Forbes magazine that predicts that hospitals will actually be worse off financially if Medicaid is expanded.

We have looked at the studies carefully and compared them to what we see in our own community, and we do not anticipate that Medicaid expansion will hurt our hospital. Our analysis is that thousands of uninsured people who use our emergency room as their only source of care will have better quality and more cost-effective options for primary and preventive care, and that will result in a positive economic result to Elliot and the community.

However, the larger view for us is that a purely economic calculation misses the point. Medicaid expansion is not about profit and a hospital’s bottom line. Of course it’s important to have enough revenue to balance the cost of the care we provide to the community, however our mission is about health care, not profits.

We are here to take care of the people in our community who need the best health care available, regardless of their ability to pay for it. Last year, Elliot provided more than $131 million in unfunded care to the community. This included charity care for those who do not have the means to pay, and community benefit activities whereby Elliot provided such things as education, research and subsidized health services for the community. Also included in the unfunded care are the Medicare ($37,077,080) and Medicaid ($40,251,923) shortfall and bad debt. Almost 60 percent of the uncompensated care to the community comes from the medical care provided to the elderly and indigent without reimbursement from the state and federal government for the cost of that care.

Medicaid expansion is about people who are suffering and in great need. Putting a Medicaid card in the hand of a mom with two children so her kids can go to a primary care doctor for an annual checkup is more than economics. Helping a working dad get care for his cancer without financial ruin so he can still put food on the table is more than economics.

Yes, there is a safety net. People can go to the emergency room in a crisis, and yes, the hospitals have to treat them regardless of their ability to pay. We can do better. Imagine how empowering it is to have the ability to make a doctor’s appointment before a minor issue becomes life-threatening. Imagine how liberating it is to the single mom who wants to care for her children to have the ability to get them medicine. Imagine how humane it is to treat high cholesterol and high blood pressure before the heart attack or stroke.

That is what expanding Medicaid is about. The news stories talk about the tens of thousands who could be eligible for Medicaid and the billions of dollars that the federal government will infuse into New Hampshire’s health care system if Medicaid is expanded. Other stories, like the Forbes article, tell us of the costs and drawbacks to expansion. We are skeptical about any analysis that says hospitals will be hurt by Medicaid expansion because that is not what our forecast shows.

However, if tens of thousands of people in our community get care in exchange for a little less hospital revenue, that is a trade-off that is easy to reconcile with our mission!